Complex myomectomy: A case report and literature review

J.V.K Kibunja, L.W Njiru, F.N Kagema
In: Journal of Obstetrics and Gynaecology of Eastern and Central Africa · 2021 · vol. 33(3) , pp. 97–100 · doi:10.59692/jogeca.v33i3.445 · W4404698867
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This case report and literature review describes the surgical management of a 40-year-old nulliparous woman presenting with primary infertility, heavy menstrual bleeding, and symptomatic anemia. The patient underwent a complex myomectomy involving the excision of 80 uterine fibroids of varying sizes and locations using tourniquets, vasopressin, and bilateral uterine artery ligation to control hemorrhage. The authors conclude that while removing such a high number of fibroids is feasible, it requires meticulous technique by an experienced surgeon to minimize blood loss. Relevance to endometriosis: This paper focuses exclusively on uterine leiomyomas (fibroids) and does not discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Background: Myomectomy is the surgical removal of fibroids with the preservation of the uterus for future childbirth. It may be complex when adhesions, multiple myomas of different sizes are present in various sites, and a repeat myomectomy.Case presentation: A 40-year-old nulliparous presented with primary infertility. She reported having heavy and prolonged menstrual bleeding that led to multiple blood transfusions due to symptomatic anemia. Physical examination revealed a palpable mass that was irregular, mobile, non-tender. Her fundal height was 16 weeks. Pelvic ultrasound demonstrated multiple uterine fibroids of varying sizes and locations. The patient desired fertility and was therefore scheduled for myomectomy. A total of 80 fibroids were excised. Tourniquet and vasopressin were used to reduce hemorrhage. Bilateral uterine artery ligation was done to achieve hemostasis.Conclusion: Myomectomy complicated by multiple myomas up to 80 in number is possible. However, a meticulous surgical technique of myomectomy by an experienced surgeon is required. The use of tourniquet and vasopressin is vital to reduce hemorrhage during the operation.
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Background

Myomectomy is the surgical removal of fibroids with the preservation of the uterus for future childbirth. It may be complex when adhesions, multiple myomas of different sizes are present in various sites, and a repeat myomectomy. Case presentation: A 40-year-old nulliparous presented with primary infertility. She reported having heavy and prolonged menstrual bleeding that led to multiple blood transfusions due to symptomatic anemia. Physical examination revealed a palpable mass that was irregular, mobile, non-tender. Her fundal height was 16 weeks. Pelvic ultrasound demonstrated multiple uterine fibroids of varying sizes and locations. The patient desired fertility and was therefore scheduled for myomectomy. A total of 80 fibroids were excised. Tourniquet and vasopressin were used to reduce hemorrhage. Bilateral uterine artery ligation was done to achieve hemostasis.

Conclusion

Myomectomy complicated by multiple myomas up to 80 in number is possible. However, a meticulous surgical technique of myomectomy by an experienced surgeon is required. The use of tourniquet and vasopressin is vital to reduce hemorrhage during the operation. Downloads Published Issue Section Categories License Copyright (c) 2021 The Authors. This work is licensed under a Creative Commons Attribution 4.0 International License.

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